Observer

2011
Vol. 5 No. 1
Developmental
Observer
The Official Newsletter of the NIDCAP® Federation International
NIDCAP Federation
International (NFI)
Making Progress Over the Last 20 Years
Founded in 2001, the NFI is an
international, non-profit membership
organization. The NFI encourages the
implementation of developmental care
and assures the quality of the Newborn
Individualized Developmental Care
and Assessment Program (NIDCAP)
approach in all intensive, special care and
newborn nurseries around the world.
The NFI serves as the authoritative
leader for research, development,
and dissemination of NIDCAP, and
for the certification of trainers, health
care professionals, and nurseries in the
NIDCAP approach.
The NICU at Elliot Hospital, Manchester, New Hampshire
“Patience and perseverance have a
magical effect before which difficulties disappear and obstacles vanish.”
John Quincy Adams quotes
(6th US President [1825-29],
eldest son of John Adams,
2nd US President [1767-1848]).
Table of Contents
Making Progress................................... 1
Brest NICU Achieves NFI NIDCAP
Nursery Certification................................. 3
Transitions Within the NFI Board............ 4
NIDCAP Profile........................................... 6
Family Voices.............................................. 9
NIDCAP Training Centers From Around
the World................................................... 12
Current Developmental Research......... 14
Supporting Families................................. 16
As in all large projects,
our NIDCAP certification
started with an impassioned
person who was exposed to a
new idea, who then shared
that idea with someone
who cultivated a vision.
That vision, having gone
through the fires of reformation brought on by changing staff, financial highs
and lows, and what we call
Front row left to right: Shari DeYoung, PT, BS; Terri Jones,
“life,” persisted due to the
RN; Kristy Hanson, RN, Back row left to right: Pamela Bedford,
desires that were born in
RNC, BSN; Elaine Pino RN, BA; Maureen Lemay, RN, BSN
our unit about six years ago.
Herein lies the beginning and middle of our NIDCAP story, but of course the
ending will never be written—it will be lived out daily with our families.
A
s is common with many Newborn Intensive Care Units, or so it seems, ours has
evolved from meager beginnings. The NICU started in a small basement space
housing six incubators and three cribs, a few nurses and one very passionate neonatologist. Developmental care was seen by our nurses as primarily a physical therapy
initiative back then. By the middle of 1993, we were delighted to have moved upstairs
into a single large room with a capacity for 17 beds and two critical bed spaces tucked
into its framework. Our nurses started to become more aware and intrigued with
developmental care interventions through continuing education opportunities, promoted by our physical therapist and an inspiring newly hired nurse who had recently
come from a hospital where developmental care was part of the routine patient care.
By March of 2005, we had moved into our current unit, complete with 14 private and
semi-private rooms and a capacity for 23 patients; its design was based on the 2002
Newborn ICU Design Standards from the Fifth Consensus Conference. The NICU
is now staffed with 40 nurses and five neonatologists. The planning and development
of our new “state of the art” structure was due to the forward thinking of several key
directors, staff members and parents who had an innate appreciation for the emerging
practice of developmental care for the newborn. Our unit’s Nursing Director, seeing
this new unit she had spearheaded, rightfully realized that this specialized environment was just the beginning of a much greater project to bring an educated practice of
developmental care to our NICU. What has followed was the further support found
Continued on page 2
in the actions taken by our Developmental Care Committee in
the form of staff education, the integration of a Developmental
Care Specialist position and finally, our NIDCAP certification
program which was formulated in conjunction with our Developmental Care Specialist and NICU Leadership. The six of us
that are working towards our NIDCAP certification represent
the most recent steps towards the goals that were set into action
years ago--even before five out of the six of us began working at
Elliot Hospital.
How NIDCAP Training Began
Moving to this newly designed unit was truly inspirational.
Family-centered, developmentally supportive care seemed to
flourish overnight, regardless of any human intervention. The
nursing director overseeing our beautiful “state of the art” NICU
repeatedly encouraged us all to “Shoot for the stars!” This was
the inspiration needed and the time was right. Over the next six
month period, the new Developmental Care Specialist constructed
a comprehensive NIDCAP training proposal. She presented it to
the nursing director, hospital administrators, the hospital Board
of Directors and the Mary & John Elliot Charitable Foundation,
a non-profit, charitable organization created to provide financial
support to the various needs of the Elliot Health System. The proposal was accepted and the funds were allocated for the training
of six NICU staff. In preparation for the training, Master Trainer
gretchen Lawhon, RN, PhD was contacted and planning continued with the Developmental Care Specialist and NICU leaders.
A large multidisciplinary group including two former NICU
parents was formed and was referred to as the NIDCAP Leadership Committee. This committee was charged with filling out the
NICU Site Assessment and was later transformed into a powerful
steering committee that focused on family centered care and the
implementation of the NIDCAP process. Simultaneously, a selection committee was designated to define and carry out the trainee
selection process. Five NICU nurses and one physical therapist
were selected for training which began on January 25, 2010.
Meet the Trainees
The NICU’s Developmental Care Specialist, Pamela Bedford,
RNC, BSN provides the leadership for the NIDCAP Trainees
while simultaneously going through the training herself. This
model of embedded leadership allows for both collaboration and
role modeling as the training progresses. Pam is dedicated to the
challenge of practice and culture change in the NICU and hopes
to further this through the implementation of NIDCAP Training. She is proud to say that the entire NICU team recognizes
an elevated standard of care as family-centered developmentally
supportive care that has become ingrained into their patient care
delivery in our NICU.
Kristy Hanson, RN, ADN a Clinical Leader on the night
shift, is in an excellent position to spread her NIDCAP knowledge to our colleagues and her dedication to this training
provides an important level of credibility for the staff. Kristy has
been actively committed to the implementation of the developmental care program since the first developmental care committee formed. She has been instrumental in supporting the program and NIDCAP Training from a management perspective.
Kristy chose to be NIDCAP certified to enhance her knowledge
and better support the NICU staff with individualized, familycentered, developmental care planning.
Elaine Pino RN, BA brings twelve years of neonatal nursing
to the NIDCAP work and demonstrates an especially strong attitude toward the multidisciplinary approach to care in the unit.
She would like to be NIDCAP certified because she believes that
improving her observational skills will allow for a more consistent and sensitive approach to caregiving. Elaine also recognizes
the need for all newborn caregivers to gain a higher level of
understanding for developmentally supportive care.
Maureen Lemay, RN, BSN was a newly graduated nurse
when she started working in the NICU eight years ago. She
has been an active member of the NICU Developmental Care
Committee and is the NICU’s resource nurse for breastfeeding
and bottle feeding practices. Maureen strives to make a greater
impact on care delivery through supporting the sensitive attunement of care providers and parents to the infants’ neurobehavioral organization. She came to NIDCAP Training with the
expectation that it would facilitate more family-centered individualized care plans and improve the overall quality of care.
Shari DeYoung, PT, BS has 18 years of newborn experience
along with her genuine enthusiasm for the NIDCAP work.
Shari’s perspective as a physical therapist trained in the Neonatal
Oral Motor Assessment Scale (NOMAS®),1 adds to the group’s
Developmental
Observer
A semi-annual publication of the NIDCAP Federation International
© 2011. The statements and opinions contained in this newsletter
are solely those of the individual authors and contributors and not
necessarily of the NIDCAP Federation International. Articles from the
Developmental Observer, duly acknowledged, may be reprinted with
permission. Please contact us at: developmentalobserver @ nidcap.org.
2
•
2011
Senior Editor
Rodd Hedlund, MEd
Associate Editors
Deborah Buehler, PhD
Sandra Kosta, BA
gretchen Lawhon, RN, PhD
•
Developmental Observer
Contributions
We would like to thank all of our individual donors for their generous
support of the NFI and its continuing work.
overall level of expertise. She has facilitated a number of developmental care initiatives in the NICU over the years. Shari joined
NIDCAP Training with the objective of expanding her knowledge base and improving her observational skills in order to
enhance developmental care practices and parent education. She
anticipates that the process will help to integrate a team approach to
infant care.
Terri Jones, RN brings a wealth of experience from a variety of
different settings including Oakland Children’s which was in the
forefront of individualized developmentally supportive care since
the mid-eighties. Terri’s nearly twenty years of neonatal nursing
experience makes her an ideal trainee as well as an excellent role
model. Through NIDCAP Training, Terri expects to be able to
apply her new skills and knowledge within her own practice; to
be an effective resource for all disciplines; and to make improvements to the care practices in the NICU. She feels that NIDCAP
is a perfect fit for her because its concepts are aligned with her
professional values and motivation for promoting the family unit.
As time has evolved, a larger percentage of our families are
staying at the bedside and thus have a direct impact on their
baby’s care. It is an evolution that has been born out of a more
sincere, honest commitment from our nurses and other care providers to invite them to stay. This progression has been guided
by the Leadership Committee who defined and acknowledged a
commitment to include parents in rounds and to hold ourselves
responsible for opening up communication between parents and
staff. It was NIDCAP that gave our vision a name and a face for
all of our staff.
The End Result
The family has taken a principal role in nurturing and caring for
their infant and our unit has changed for the better! Our parents
have a visible place here - on their terms, not just on ours. Of
course, we now have a new set of challenges but we will continue
to shoot for the stars!
After 19 months of NIDCAP training, we are so pleased and
excited for the NIDCAP Reliability Day scheduled for September 12th of this year!
NIDCAP Training Update
Congratulations are offered to each one of these outstanding
women of “The Elliot Six” who have now successfully transformed themselves from NIDCAP Trainees to NIDCAP Professionals as well as to their supportive staff and administration of
the Elliot Hospital Newborn Intensive Care Unit. This NICU
has been “forever changed” by the growth and development
highlighted in the six remarkable Advanced Practicum experiences of six infants and their families which became a multidisciplinary unit-wide implementation of NIDCAP.
References
1. Palmer M. Neonatal oral motor assessment scale (NOMAS®). 1983
The Brest NICU Achieves NFI NIDCAP Nursery Certification in 2011
Jacques Sizun, MD
The Brest NICU Team is very happy to have achieved the
NFI NIDCAP Nursery Certification.
The NIDCAP Nursery Certification Program (NNCP) was
seen as an institutional quality improvement process and an opportunity to share the philosophy of NIDCAP in a whole Mother
and Child Department (Brest University Hospital).
The process started in early 2010 with the translation of
the NNCP Criterion Scales Manual1 supported by the Brittany
Regional Hospital Agency. Then four groups of professionals
worked hard to perform the self-evaluation suggesting 10 points
of improvement. The Department Board selected five actions in
October 2010 for immediate changes.
The NNCP Site Review visit took place in December,
despite a snowstorm at the Paris Airport! Parents, staff and
directors were very excited by these three days of interviews,
document analysis and observations.
Next steps: To pursue the quality improvement process
toward a more individualized family-centered approach to care;
to present this NNCP experience to our National Certification
visitors from the Haute Autorité de Santé in September 2011;
and to share this experience with European NICUs.
Reference:
1. Smith K, Buehler D, & Als H. NIDCAP Nursery Certification Criterion Scales. 2008.
Boston, Mass: NIDCAP Federation International, Inc.
The Brest NIDCAP Team holding the NNCP Award. Pictured from
left to right: Sylvie Minguy RN, Isabelle Olivard RN, Cathy Boucher
RN, Jacques Sizun MD, Maryvonne Quénéa RN, Nathalie Ratynski
MD, Béatrice Kerleroux RN.
NIDCAP Nursery Certification was celebrated during the first Frenchspeaking annual NIDCAP meeting in Brest, May 26-27, 2011.
Developmental Observer
•
2011
•
3
Transitions within the NFI Board of Directors
gretchen Lawhon, RN, PhD and Deborah Buehler, PhD
Following the recent election at the NFI Membership meeting in September there has been a change within the NFI Board
of Directors and we would like to express our appreciation to two departing Board Members of long standing as we welcome two new Board Members. The NIDCAP Federation International would like to acknowledge the many contributions
of two Board Members, Karen M. Smith, RNC, MEd and Roger Sheldon, MD, MPH, who have completed their terms.
Karen Smith, RNC, MEd is the
Clinical Developmental Specialist and
Developmental Care Educator with
the Newborn Intensive Care Unit and
NICU Follow Up Clinic at St. Luke’s
Regional Medical Center in Boise,
Idaho. She has over twenty-eight years
of neonatal nursing experience and
has been involved with NIDCAP
since 1989, when she became a
NIDCAP Trainee through the University of Washington Infant Transition Project. While Ms. Smith
was working on her basic NIDCAP training, she made a decision
and firm commitment to become a NIDCAP Trainer. Much to
her credit as well as dedication and perseverance, Ms. Smith realized her goal of becoming a NIDCAP Trainer in record time. In
1995, Ms. Smith created the St. Luke’s NIDCAP Center in Boise,
Idaho. She has been attending our annual NIDCAP Trainers
Meetings since 1992 and hosted two of them in the breathtaking
Idaho surroundings of McCall in 1997 and Sun Valley in 2006.
Prior to becoming a member of the NFI Board of Directors, Ms. Smith was and remains a highly valued and active
NFI member who has been the Co-Chair of the Committee on
NIDCAP Nursery Acknowledgment. As a Board Member, in
2004 Karen agreed to chair that committee and renamed it the
Nursery Recognition Committee. Re-elected in 2005 and again
in 2008, Ms. Smith continues to provide enormous energy and
exemplary leadership in growing the NFI NIDCAP Nursery
Certification Program (NNCP). Further, Ms. Smith and her
colleagues created an exemplary NFI-certified NIDCAP Nursery
in their own hospital. From being the first in the pilot phase for
the NNCP, Karen experienced and continues to help to refine
the process for her own and other units. The Newborn Intensive
Care Unit at St. Luke’s Medical Center is an ideal flagship for
the NNCP and provides both the nurturing environment for
infants, families and staff combined with the most respectful attitude and care that is the NIDCAP model.
Ms. Smith is a Master NIDCAP Trainer and is nearing
completion of her APIB Trainer training. She teaches NIDCAP
on a global basis including units in the United States, Norway,
Italy and Taiwan. With great appreciation for her direction, leadership and dedication, we thank Ms. Smith for her past seven
years of amazing productivity as a member of the NFI Board of
Directors. And we are grateful that she has agreed to continue
her invaluable contributions with the NFI and the NNCP in her
role as Co-Chair of the NNCP Committee.
4
•
2011
•
Developmental Observer
Roger Sheldon, MD, MPH has also
completed seven years of service as a
member of the NFI Board of Directors. Dr. Sheldon was one of the very
first neonatologists to participate
in NIDCAP training both from
an administrative and individual
professional perspective in the early
eighties. He provided the medical
leadership and support for the first
NIDCAP Training Center outside
of Boston with the creation of the Sooner NIDCAP Training
Center at Oklahoma Children’s Hospital in Oklahoma in 1986.
Dr. Sheldon and his colleagues in Oklahoma hosted two of our
annual NIDCAP Trainers Meetings, one on Monkey Island in
1994 and the other in Oklahoma City in 2004. Both of these
meetings provided NIDCAP professionals with unique Midwestern cultural experiences and a special perspective on Native
Americans.
Dr. Sheldon was first elected to the NFI Board of Directors
in 2004 and was re-elected twice in 2005 and 2008. He joined
the Nursery Recognition Committee in 2005 and has served on
the NNCP Committee as Chair of the Application Subcommittee, from 2006 to 2008. He has been actively involved as a
physician site reviewer, offering his invaluable perspective to the
pilot process and now the actual program. In 2005, Dr. Sheldon
joined the newly established NFI Membership Committee and
provides much appreciated contributions to that committee.
Further, he serves with leadership and diligence on the Nominations, Appointments and Elections Committee since 2006 and
was the Chair of the Outreach Committee since 2009.
Recently, Dr. Sheldon has retired from his long standing position as Professor of Pediatrics with the University of Oklahoma
and Medical Director of the Oklahoma Infant Transition Program
and Sooner NIDCAP Training Center and moved to Minnesota.
Although Dr. Sheldon has completed his tenure on the NFI
Board, he graciously will continue to be an active NFI member,
NNCP Site Reviewer, and has committed to continue the work
he began on publishing an evidence review article on NIDCAP
within the context of the American Academy of Pediatrics.
With deep appreciation for their countless and ongoing
contributions, we stand to honor Karen Smith, RNC, MEd and
Roger Sheldon, MD, MPH. for their seminal work with the
NIDCAP Federation International.
The NFI Board of Directors would like to welcome our two newly elected members, Jeffrey Alberts, PhD and
Inga Warren, Dip COT, MSc.
Dr. Alberts is a Professor of
Psychological and Brain Sciences at
Indiana University, Bloomington.
He has devoted much of his career
to studying behavioral, sensory, and
physiological aspects of development
– in fetal, newborn, and infant
rodents (i.e. rats and mice). He
has received research support and
recognition from the National
Institutes of Health (NIMH and
NICHD), the National Science Foundation, and NASA,
including a Research Scientist Development Award and a
MERIT award from the NIH. While maintaining his lab and
teaching, he served for 12 years in administration at Indiana
University as Associate Vice President for Research. Since 2010,
Dr. Alberts has been a NIDCAP Trainee at Cincinnati Children’s
Hospital.
Inga Warren, DipCOT, MSc is the
Director and Lead Trainer for the
UK’s NIDCAP Centre, based at St.
Mary’s Hospital, linked to Imperial
College and a network of neonatal
units in Northwest London. As an
occupational therapist, she has
worked in neonatal care since 1990
with children and families from a
wide variety of healthcare settings,
Ms. Warren’s main area of interest
currently is education and finding innovative and effective ways
to make the NIDCAP philosophy and principles more widely
known and understood and the training more accessible. In
recent years, her work has taken her to fourteen countries, and
she is interested in how NIDCAP can be adapted to meet the
different challenges that each country, and indeed each unit,
faces and how to set them on the path to NIDCAP.
Assessment of Preterm Infants’ Behavior (APIB)
The Assessment of Preterm Infants’ Behavior (APIB) is a comprehensive and systematic neurobehavioral assessment
of preterm and fullterm newborns developed by Heidelise Als, PhD and her colleagues (published in 1982, see
www.nidcap.org for details). The APIB requires in-depth training and provides a highly valuable resource in support
of developmental care provision by professionals and families.
Newborn Individualized Developmental Care and Assessment Program (NIDCAP)
The Newborn Individualized Developmental Care and Assessment Program (NIDCAP), originated in 1984 by
Heidelise Als, PhD, is a developmental, family centered, and evidence-based care approach. NIDCAP focuses on
adapting the newborn intensive care nursery, including all care and treatment and the physical environment, to the
unique neurodevelopmental strengths and goals of each high risk newborn and his or her family, the infant’s most
important nurturers and supporters. For a complete description of training centers and the training process please
visit our website: www.nidcap.org.
NIDCAP Nursery Certification Program (NNCP)
The NIDCAP Nursery Certification Program (NNCP) under the auspices of the NIDCAP Federation International (NFI)
recognizes the excellence of a hospital nursery’s commitment to and integration of the principles of the Newborn
Individualized Developmental Care and Assessment Program (NIDCAP) for infants and their families. NIDCAP Nursery
Certification is both a goal and a process. Nurseries that apply for this certification will, by the process of the application
and by their self evaluation, define the areas of their current strengths and areas for future growth. Successful NIDCAP
Nursery Certification represents distinction in the provision of a consistently high level of NIDCAP care for infants and
their families, as well as for the staff, and as such is to be commended and celebrated as an inspiration for all. For
information on eligibility requirements and the certification process please see: www.nidcap.org; and/or contact the
NNCP Director at: nncpdirector@nidcap.org or 785-841-5440.
Developmental Observer
•
2011
•
5
NIDCAP PROFILE, IN MEMORIAM
Martha Hayden Kendal Holmes, BFA, MSW
August 5, 1945 – June 27, 2011
Martha Hayden Kendall Holmes, BFA, MSW was born August 5,
1945 in Sayre, Oklahoma, to Marie Hayden and James Melton Kendall.
She grew up in Sayre and graduated from Sayre High School in 1963.
Martha received a Bachelor of Music, 1970, University of Oklahoma and
a Master’s Degree in Social Work, 1976, University of Oklahoma (OU).
During the 1970s, Martha was one of the original people to organize the
Oklahoma City Parents Assistance Center. She was a Clinical Assistant
Professor of Pediatrics at the University of Oklahoma Health Sciences
Center. In 2009 Martha, and her life companion Tedd Fulp, were presented
with the Phil Wahl Abolitionists of the Year Award, from The Oklahoma
Commission to Abolish the Death Penalty. Martha was preceded in death
by her parents, Marie and James; her sister, Norma Jane; and her husband,
Fred. She is survived by her life-partner, Tedd Fulp; her niece, Marquita
Lopez, and her husband, Tony; several cousins; numerous long-term friends;
and her beloved and faithful dogs, Buddy and Gypsy. Martha was blessed
with the ability to develop and maintain friendships and was known as an advocate for children and families who went
the extra mile to achieve positive results. She will be dearly missed by those who knew and loved her (excerpted from “The
Oklahoman” July 10, 2011).
The reflections of Martha below celebrate her life, work and the dynamic and innovative person that she was. For
those of you who had the opportunity to know Martha, she was a rare gift indeed…“What a gift! What a life! What a gal!”
(from The Oklahoma Commission to Abolish the Death Penalty, In Memory & Gratitude for Martha Kendall Holmes,
June 27, 2011).
A Remembrance
T
he NFI and the NIDCAP world suffered an enormous loss
on June 27 when Martha Kendall Holmes died unexpectedly at her home in Oklahoma City of an apparent heart attack.
The Sooner Training Center and the Neonatal Section at the
University of Oklahoma as well as colleagues from other parts of
her life mourned her passing at a memorial service held on July
12. I shared some of my thoughts, but I also learned about my
friend and colleague of 31 years. We heard about her dedication to the NICU infants and their families, about her musical
talents, her devotion to social work, and her many service
contributions to causes like the Coalition to Abolish the Death
Penalty, ZONTA International (a global organization working
to advance the status of women worldwide through service and
advocacy), and the Democratic Party. And we heard about her
beloved dogs.
Martha was born in western Oklahoma where, her childhood friends recalled, she distinguished herself as a good friend
and excellent musician even in grade school—every performance
of soloist or choir in Sayre, Oklahoma in the late ‘50’s seemed to
6
•
2011
•
Developmental Observer
be accompanied by Martha Kendall. These talents earned her a
place in the piano program at the OU Music School starting in
1959. One of her soloists from that time sang at the memorial
service and remembered her friend and accompanist as a standout musician and loyal friend. How many people do you know
who can play any song in any key—just by hearing the melody?
And she could dress it up with rhythms, arpeggios and glissandos
you wouldn’t believe. Martha had a musician’s heart and soul.
My most moving musical memory of Martha came when she
improvised accompaniment for another close friend, an operatic
and professional soprano, to sing and play “Sweet Little Jesus
Boy” off the cuff at a Christmas gathering in my home. I still
tear up remembering the soft and sweet music they made.
However, she also had a heart and soul for the children and
the disadvantaged. She earned her Masters’ in Social Work from
OU and began working in child welfare for the State Department of Institutions, Social and Rehabilitative Services (now
called the Department of Human Services). She moved to the
Children’s Hospital as the only social worker in our 35-bed
NICU. It was there I met her in 1979 and quickly came to respect the huge difference she could make in the experience (and
the lives) of the NICU parents, and thus their babies. When a
grant became available to start the Oklahoma Infant Transition
Program (OITP), Martha was the obvious choice to lead this
team of social workers and family advocates in enhancing our
services to families.
It was in this post in the early 80’s that Martha noted, and
quickly understood the importance of Wheelock College’s Project Welcome and the NIDCAP revolution underway at Boston
Children’s. She visited both and came home with the idea for extending NIDCAP to Oklahoma. I was uncertain about this, but
she convinced me (I can be slow sometimes) that it was the right
way to build families and better babies, and that we should look
into it. Therefore, she convinced Heidi Als, PhD and gretchen
Lawhon, RN, PhD to visit Oklahoma City and show us how it
was done. Heidi recalls being impressed that we had numerous
doctors in the audience right from the start—Martha made that
happen.
We also learned that it could take longer than one visit to establish a training center, but Martha would not be deterred, and
we were able to start the first NIDCAP Training Center outside
Boston. She took the Training Center into her OITP program
and secured state and federal funding, selling it as an expanded
transition service for building families and improving outcomes.
It continues there, more than 20 years later.
Looking back, I am amazed at the prescience and perception
that allowed her to see this opportunity and bring it to pass. She
truly understood the implications of NIDCAP and developmental care before anyone else outside Boston. What a change she
made in our care of babies and families!
Martha was also central in the founding of the National
Association of Perinatal Social Workers, and very active in the
National Association of Social Workers, which honored her as
National Social Worker of the Year in 1999. Our trip to Washington for the presentation was a wonderful experience; the
award was well-deserved. Martha also served the NASW again as
Executive Director of the Oklahoma Chapter during the last few
years of her working career.
Martha didn’t have an easy life—an unassuming small town
start, the loss of her husband of two years in an auto accident, a
long and hard career in high-pressure environments—but you
never heard her complain or bemoan her lot. She prevailed and
made enormous contributions to the wellbeing of our patients
and families in Oklahoma, and by extension all over the nation.
The babies and families don’t know it yet, but they too will miss
Martha Holmes, almost as much as I do.
Roger Sheldon, MD, MPH
Emeritus Professor of Pediatrics (Neonatology)
University of Oklahoma
“A Mover and a Shaker”
M
artha was a mover and a shaker, although my memories of
her were of her sitting at a desk in the Oklahoma Infant
Transition Program calmly directing the activities and being
there for anyone who needed someone to listen and to care.
Martha was also formidable. When she was not happy with a
decision or an activity, she would say “Well, we’ll just see about
that.” The next thing I knew, the issue had been addressed and
the people involved were pleased with the outcome. When she
wanted something done, it was always “Well, that just needs to
happen and we will make it happen.” And it did.
My first encounter with Martha was when I moved from
New Mexico, a newly trained and reliable APIB administrator,
to Oklahoma. I received a call from a friendly sounding woman
who said “You need to come and work with us.” No, “Hello,
welcome to Oklahoma!” No, “What education and experience
do you have?” No, “Would you like to work with us?” It was
another example of “whatever Martha wants, Martha gets.” Her
positive attitude and “can do” approach is why she was such a
wonder back then and what her legacy represents.
Martha loved classical piano music, but she really loved
her dogs. She enjoyed knowing that her oldest dog was named
“Duffy,” a familiar name in the NIDCAP world. Martha adopted and had three feisty dogs at a time. She proudly displayed
their portraits on her desk. She also loved going to the most recent movie releases. She spent much of Thanksgiving and Christmas day in the theater and entertained us with her evaluations of
the screen play and the acting, not to mention the music score.
Martha’s spirit lives on in the people who learned that her
enthusiasm, perseverance and being certain with what you
believe in are keys to moving our work forward. I will miss her
grace, her poise and her always open ear both to the music of the
piano and the tempo of the people she worked with.
Joy V. Browne, PhD, PCNS-BC, IMH (IV) Mentor
Professor, Departments of Pediatrics and Psychiatry, UC SOM
Director, Center for Family and Infant Interaction
“A Broad Thinker and Innovative Visionary”
M
artha passed away unexpectedly on June 27, 2011. She
and I had a telephone call scheduled upon my return from
international NIDCAP Training travel that took me to Shanghai,
China. Needless to say, Roger Sheldon’s email informing us that
Martha had passed away came as a great shock.
I heard of Martha first in 1982; gretchen Lawhon RN, PhD
with whom I worked at the Brigham and Women’s Hospital
(BWH) at the time in developing a teaching and training framework for our NIDCAP research, told me that a social worker
from Oklahoma had come to visit her and Alexandra Melzar,
our first in-house “NIDCAP Trainer.” Martha had heard that
the BWH NICU does things differently from other NICUs and
she had decided to come and see for herself. As she told me later,
“The NICU was dark and quiet and the nurses were very quiet,
there were parents everywhere, the incubators had covers draped
over them; babies on warming tables slept under sun umbrellas or behind blankets hung tent-like from the radiant warmers
above them shielding them, from their surroundings. She saw a
mother breast feeding her baby sitting in a padded chair next to
the baby’s incubator.” She was determined to make this happen
also in Oklahoma at the University Hospital’s NICU.
Developmental Observer
•
2011
•
7
She convinced Roger Sheldon, MD the medical director of
their NICU, to invite gretchen and me to come to Oklahoma
City and teach the neonatologist and nurses about this work and
how to see and read the baby. This is how NIDCAP training at
other sites began. I am convinced that gretchen and I learned
more during our visits to Oklahoma than “our students” would
have imagined. Eager students go a long way to create passable
teachers. The motivation and determination of the group and
the insight and leadership that Martha and Roger brought to
the process was assuring and validating. The “Oklahoma group”
did their assigned homework and they wanted us to come back!
Soon they decided that they wanted to establish a Training
Center of their own so that they could train more of their staff
and those at neighboring NICUs and in the State. The rest is
NIDCAP history. And thus NIDCAP Trainer Training and Center development was born. Martha was invested in improving
the State’s infant health and development situation and support
parents of high risk infants from the very beginning. Under her
leadership the Oklahoma Infant Transition Program, funded by
the State of Oklahoma, worked with families in the NICU and
upon discharge into the community. NIDCAP would fill in the
piece from NICU admission forward.
Martha was a broad thinker and innovative visionary and
determined to improve the lives of all infants and families and
most of all of those who were in greatest need of support. She
was an avant garde social revolutionary, and was so in one of the
most conservative states in the US. And Martha was the only social worker the formal NIDCAP family has ever had as member
or as Center Director, which in itself speaks for her uniqueness.
Martha and I became good friends. I learned about her
earlier life before Social Work, her training as classical concert
pianist, her love for music, all music and particularly classical
music, Chopin, Mozart and many others. There was always a
record, or later a CD, playing at her home. And she introduced
me also to the music of country singer Reba McEntire (whom
everyone knew it seemed except I); she taught me about American Indian culture, Red Earth, and the Trail of Tears (she sent
me a book to read to inform myself ) and she took me to the
American Indian Museum to enrich my understanding. Martha
shared with me the tragic story of her very brief and cruelly curtailed marriage, when her new groom was killed on the spot in a
terrible car accident on his way to meet her at a restaurant where
she waited for him for a meal together as newlyweds.
I learned that Martha not only cared for babies, their
families, other professionals and for people in general, but she
also cared for dogs. And she always had at least one or two dogs,
they always had tragic pasts and/or were otherwise “in-need-of
being-cared-for.” One little very sweet dog I met had been so
abused that she had become blind. Martha gave her a loving
home; one was named Duffy (my husband’s last name) whom
she had adopted when the family who owned him no longer
was in a position to care for him. Martha promptly sent me a
photo of her own Duffy and a children’s book, “Duffy on the
Farm,”1 explaining that she hoped that Frank would understand
8
•
2011
•
Developmental Observer
the choice of name. We still have the book and Frank and the
children loved it.
Martha was a pioneering multi-culturist; many of you will
remember fondly the NIDCAP Trainers Meeting exercise BaFa’
BaFa’ that Martha led in order to help us all become culturally
more sensitive. We learned a great deal about ourselves and one
another, regardless of which population group we belonged to
and what ‘language’ (words were not allowed for communication among these preverbal groups, only gestures, as two very
different population groups encountered one another and were
confronted with sharing sparse resources). No doubt there are
some priceless photos in the NIDCAP archives of the NIDCAP
group’s BaFa’ BaFa’ experience.
Martha and Tedd Fulp, her life’s partner of many years,
were very gracious hosts at home and wherever we met. She was
always stylish, a smartly dressed professional, no matter what
the Oklahoma heat at the time; she wore heels always, and never
had a hair out of place. She made me often feel like sprucing
up my appearance a bit. Martha was a most generous person,
always fully present for her company, and she always took action
to help others in a thousand small ways and in very big ways.
She helped a young pregnant Oklahoma woman who attempted
to take her life by shooting herself just outside of a Mall, and
ended up in the ICU with brain damage. Martha found her
and her husband the multidisciplinary services required to heal,
recover and carry the baby to term, a big nearly 10 pound baby
boy, and an ultimately thriving young family after such a terrific
multifaceted life’s interlude. The experience led Martha to work
on pre-partum depression, a very new topic at the time. Martha
“gave her all” for days and weeks on end in the wake of the cruel
Oklahoma Bombing; she served in the ER and she counseled
and supported numerous families and children. She supported
the Memorial Museum and planted a seedling in her garden of
the one surviving tree at the bombsite. She took me there and
shared again the perspective of caring and deep responsibility for
one another and she led a big effort to abolish the death penalty in Oklahoma, even for Timothy McVeigh, the Oklahoma
bomber, in her mind foremost a person and in need of redemption and rehabilitation. I admired Martha, her principles and
steadfast convictions, her ethics and integrity. I miss Martha.
Her memory will carry and guide us who knew her, for many
years to come. She has made the world a better place for all of us
by who she was and what she stood for.
In sadness, and grateful to have known Martha for
many years.
Heidelise Als, PhD
Associate Professor of Psychology in the Department
of Psychiatry, Harvard Medical School
Director, Neurobehavioral Infant and Child Studies,
Children’s Hospital Boston
Reference
1. Marilyn Elson. Duffy on the Farm. Illustrated by Lisa McCue. 1984. Golden, Western
Publishing Co. New York and Racine, Wisconsin.
FA M I LY V O I C E S
Shirly Benor
Our Journey to Breastfeeding
• Enjoy skin-to-skin holding: I tried to provide Nitzan with
skin-to-skin holding two times a day. I placed a comfortable
arm-chair next to her incubator, so that Nitzan and I would
enjoy it as much as we could. I feel skin-to-skin holding
served an important role in creating a close connection
between me and Nitzan. It also had a great impact on my
breastmilk production. In my first pumping, after starting
skin-to-skin holding, I doubled the amount of milk
produced!
• Pump from both breasts at the same time: This saved me a
lot of time and increased my milk production rate.
• Solicit support and motivation from your partner: I recommend that other mothers support their partners to be part of
the mission; support them to be aware and involved in the
process and challenges.
Nitzan Paster Benor was born at the NICU at Meir Medical
Center, Kfar Saba, Israel on February 22, 2011. At the time
of her birth, she was 25 weeks gestational age and weighed
700 grams. Pictured are Nitzan and her mother Shirly.
M
y name is Shirly. I gave birth to my daughter Nitzan in
the 25th week of pregnancy because of severe hypertension
(pre-eclampsia). As a mother of my older child, Gefen, now two
years old, it was clear to me that I’d like to breastfeed Nitzan and
enjoy the great connection it creates between us, as well as the
nutritional and immunological advantages. When I first came
to the NICU, the doctor explained to me that human milk was
proven to minimize inflammation of the bowel wall (Necrotizing
enterocolitis; NEC) and also has a positive impact on infant outcome. During the first few days the nurses gently supported me
to start pumping breastmilk so my body would start the production of milk. But then, I discovered it is not an easy mission. It
turned out that a lot of mothers of very young premature babies
(24-27 weeks after conception) experience difficulty after a few
weeks of pumping, as it is very demanding, both physically and
mentally. I was very motivated to make this work.
Nitzan is now three months old, in her 39th week, and has
started to drink from bottles and breastfeed, some weeks ago.
Throughout this period, my own milk nurtured her, and this was
a great thing for me. As I succeeded in this mission (for now…),
I’d like to share some tips and ideas which might help other
mothers in their journey:
• Stay motivated: I kept thinking that this is the best thing I
can do for Nitzan. For me, it is part of giving life to her. The
pumping task became part of my routine and I kept regular pumping times. My previous breastfeeding experiences
helped me get through some difficult times.
• Solicit support from the nursery staff: Information, facilities
(pumping room, deep freeze, etc.) and emotional support
helped me along the way.
• Review “case studies”: I had several talks with other mothers
of older children, in order to better understand the reasons
for breastfeeding success and, at times, its challenges.
• Keep a written record: I kept a record of my pumping
amounts so I could control the total amount of milk
production and have a baseline per pumping to compare
it to.
• Take care of yourself: Drink a lot of water, eat balanced
nutritional meals, and get a good night’s sleep (although this
is not easy…).
Nitzan and I are still learning, and have a way to go with
breastfeeding. I am encouraged by what we have done so far, and
hope we can make it eventually to complete breastfeeding.
Developmental Care in the Moment
Being together with nurturance and nutrition
Photograph by Elsa Silva
Developmental Observer
•
2011
•
9
FA M I LY V O I C E S
Sarah Cluff
“In April of 2011, I was sitting in a Newborn Intensive
Care Unit (NICU) watching my nearly adult child, Jenna,
hold her little brother, only three days old. In a flash of nostalgia, I found myself completely overcome with emotion.”
O
ur journey into the world of the NICU began 18 years ago
as we welcomed our first child into our family. From that
eventful day in February of 1993 until present, we have been a
part of ten different NICU facilities, welcoming into our family
seven daughters and one delightful little boy.
Jenna was born on February 8, 1993 at 28 weeks, after weeks
of unexplained preterm labor. She weighed three pounds, five
ounces, and to me, she was the most beautiful sight I had ever the
privilege to gaze upon. My first glimpse was fleeting as half a dozen medical personnel rushed her past me into the adjoining room,
promptly hooking her up to hundreds of pounds of machinery.
It took me nearly an hour to gather the courage to disregard the
nursing staff that had been trying to prevent me from entering
the NICU, afraid, I suppose, that I would not be able to mentally
handle the sight that I was about to walk in upon.
There she was, our tiny miracle, hardly visible for all the
equipment needed to keep her alive. We stood in the corner of
the NICU for close to 20 minutes before anyone noticed “baby
Cluff ’s parents” had entered. I stood there, feeling the unbearable
ache and longing to reach out and comfort this beautiful little
creature that had been wrenched away from me far too soon. I
was scared and emotional, and I felt lonely and alone in such a
sterile, medical environment.
I was surprised at how seldom I would see other parents at
their baby’s bedside, but as the days passed I began to understand
why. I was made to feel superfluous and uninvited. I consistently
felt like an obstacle in the way of the nurses. Often I would be
10
•
2011
•
Developmental Observer
told that there was nothing I could do for my baby and I should
get some rest. Well-meaning people would even suggest that
I “take advantage” of the situation and go back to work while
I had the best babysitters in the world caring for my infant. It
seemed that at every moment, there were “professionals” trying
to convince me that I was not needed yet, and should return in
a few weeks when I was. Decisions were routinely made without
regard to my opinion, or even the slightest explanation about
why different procedures were being carried out. Asking questions would inevitably bring about patronizing answers, hastily
and loftily given. The more unwelcome I began to feel, the more
determined I was to spend every possible moment at our daughter’s bedside, commonly staying 16 to 18 hours a day.
Two days into our journey, one nurse finally asked me what
we had decided to name our daughter. At that moment, I was
consumed with intense incredulity. How could anyone look
upon these beautiful miracles and not think of them as babies
with names and families? It was a harsh concept to grasp that, to
the majority of the NICU staff, our Jenna would be only “baby
Cluff - girl,” just one of the nondescript infants passing through
the nursery. By the end of the third day, I had been allowed to
hold my daughter only one time, for a total of 15 minutes; her
daddy, James, had not yet enjoyed this privilege at all. Needing
to feel actively engaged, I would place my hand in the hole on
the side of the incubator as often as possible, and without fail, be
reprimanded by a nurse for doing so.
Every moment that followed for the next five weeks was a
journey of indescribable pain, joy, love, heartache, frustration,
and ultimately, confidence. Confidence because of one extraordinary nurse who gave us the priceless gift of education. She took
us on a journey from young newlyweds to parents.
On the fourth day of Jenna’s NICU stay, we met gretchen
Lawhon, a nurse working on her research to earn her PhD.
gretchen quietly watched us for a few minutes as we began
our daily routine of scrubbing, gowning, and sitting beside
our daughter. I will never forget the first thing gretchen ever
said to us. She said, “Jenna is beautiful. Will you tell me about
your daughter?” That was the first moment I felt like a mother.
gretchen had not only spoken of our daughter by name, but had
actually ASKED me about her! Over the ensuing weeks, gretchen
taught us how to understand our baby, how to read the subtle
signs that Jenna was giving us so we could better communicate
with her and meet her needs. We were encouraged to watch our
baby, not the monitors. We began to be more assertive with the
hospital staff, persistent about receiving explanations and indepth answers to all our many questions. We began to have the
confidence to demand that we be included in the primary care
of our daughter. gretchen taught us how to properly care for our
new little daughter, and this support has continued to bless our
lives with every addition to our family.
Our third baby daughter Abigail, born at 35 weeks was a
very healthy seven pounds, three ounces but presented us with
an entirely different set of circumstances. For reasons unknown,
she was crashing fast. Again we were shuttled up to the major
hospital over two hours away where her needs could be cared
for. In the 18 months since we had seen it, the unit had been
completely overhauled and remodeled. It was an entirely different NICU from the one we previously endured. Upon arrival,
we were met by a team of care providers whose specific intent
was to educate us about the NICU. We were offered an empty
patient room just down the hall and told it would be at our
disposal as long as the hospital didn’t need the bed for a patient.
Arrangements were again made to care for our daughters at
home, and again, the familiar routine of caring for an infant
with special needs began.
At such a healthy size and relative healthy gestation, the
cause of the crisis was not premature lungs, or inability to maintain body heat. There was no concern for typical preterm presentation of apnea or bradycardia. We faced a reality that no specialist or professional of any kind was able to discover the cause of
her rapid decline. She suffered a cardio respiratory arrest and was
intubated. As the hours passed, seizures became commonplace
and each would leave physical indents in her muscles with the
slightest touch. She had no reflexes and the results of an EEG
showed no activity. We were invited into a quiet room where we
were confronted with the cold sober faces of half a dozen medical
professionals prepared to methodically explain that our daughter
was going to die. This snapshot is seared forever into memory,
never to fade. The excruciating decision was made that life support would need to be terminated.
We left that room dazed and in shock, but not numb.
Anything but numb. Ironically, it was at this moment I absorbed
some of the many changes that had occurred in the NICU.
Several parents were sitting bedside to their tiny infants. One
mother was looking at a chart, another talking to a doctor. There
were three fathers in the room that day, two of them seemingly
there to give the mothers a much needed moment to rest, shower
From left, Jenna Cluff two years old, Abigail Cluff at 12 days old…seven days
before hospital discharge, and Mckinlei Cluff at 18 months.
or eat. In every direction,
people were holding, cuddling, feeding, or otherwise
attending to miraculous
life in the form of miracle
babies. One family was
completing the necessary
tests and paperwork to discharge their son. The boy’s
mother briefly looked in my The Cluff Family
eyes before turning away,
unable to face the pain emanating from my very soul. I found
myself hungry to sit by my daughter’s bedside, eager to again
be the obstruction in the NICU interfering with conventional
routine. Did I really, just hours ago, anticipate with horror the
weeks I might have spent here? We insisted on an exception to
the “no children allowed” so we could bring Jenna and Mckinlei
to the bedside of their sister the next morning and for one brief
moment, allow our family to be together and whole.
That night, amidst bouts of tears and unsuccessful attempts
at sleep, we received a phone call that would change the path
we were about to walk. It was about 2:30 in the morning and
on the other end of the phone was an unfamiliar voice. My first
excruciating thought was that it was too late, that our daughter
had already passed away. Unexpectedly, I was greeted by the
wonderful British accent belonging to a doctor by the name
of Niel R. Buist announcing the possibility that the source of
Abby’s overwhelming sepsis may have been discovered and was
possibly treatable. He asked our permission to begin treatment.
We were told that there was great probability that Abby’s brain
was merely paralyzed due to a toxic amount of ammonia in her
blood. We rushed to the hospital with our children where we
were educated about the extremely rare diagnostic possibility of
THAN - transient hyperammonemia of the newborn. We were
informed that the ammonia level in our seven pound daughter’s
body was well over 1000. We learned that when an adult has a
level of around 60, coma is likely. Dr. Buist theorized that if we
could wash the blood of ammonia through dialysis, perhaps her
brain would be able to wake up. This course of treatment was
started immediately.
This phenomenal man, instructed the nurses to allow our
children to see their baby sister and make arrangements for us
to have a room at the nearby Ronald McDonald House. For the
next 16 days, I rarely left Abby’s bedside. Never once did someone reprimand me for touching her too much. I was encouraged
to ask questions and told that if there was anything I did not understand they would answer, find the answer or arrange to have
the doctor come and answer any question I had. We were even
encouraged to be available when the doctors met each morning
to discuss care and treatment during “rounds”. Never once was
I made to feel like an obstruction, but rather, a vital member of
the team whose entire purpose was to heal a devastating illness
and allow our daughter to come home.
I was never denied audience with Dr. Buist and had the
opportunity to discuss with him the different NICU experiences
Continued on page 18
Developmental Observer
•
2011
•
11
NIDCAP TRAINING CENTERS FROM AROUND THE WORLD
Dorothy Vittner, RN, MSN
Connecticut Children’s NIDCAP Training Center
Seated: Tracy Brundage, MOT, OTR/L, Marla Booker, RN, BSN, Standing
Caryn Bradley, PT MMSc, Dorothy Vittner, RN, MSN, Marilyn Sanders,
MD, Ann Milanese, MD
C
onnecticut Children’s is an academic medical center with a
broad spectrum of over 150 sub-specialty services dedicated
to the care of children and their families, located in the heart of
the city of Hartford, Connecticut. Connecticut Children’s is a
young organization established in 1996 as a collaborative effort
between Newington Children’s Hospital, Hartford Hospital and
the University of Connecticut Health Center. Although it is a
relatively small hospital with 147 beds; the intensive care nursery
is a tertiary referral center for over nineteen hospitals throughout
the state and provides complex medical and surgical services to
critically ill and premature infants.
The NIDCAP Training Center at Connecticut Children’s
first opened at the University of Connecticut Health Center
in 2002 through a collaborative multidisciplinary effort between rehabilitative services, medical and nursing support and
facilitated via the leadership of Cathy Daguio, OTR/L, MPH,
MEd†, Marilyn Sanders, MD and Dorothy Vittner, RN, MSN.
The Training Center transitioned to Connecticut Children’s in
2007. The NIDCAP program was integrated into the Neonatology Program which was designated as the hospital’s inaugural
Premier Program in the fall of 2008. The intensive care nursery
embarked on a systems change initiative to support individualized developmentally supportive care practices within the nursery
and began formal developmental training in September 2009.
The Connecticut Children’s NIDCAP Training Center
provides educational opportunities on a variety of topics for
12
•
2011
•
Developmental Observer
professional staff within the hospital as well as the larger community. It is home to the University of Connecticut’s Department of Pediatrics and division of Pediatric Surgery pursuing
innovative clinical research and providing pediatric training to
over 500 physicians and allied health professionals annually.
Connecticut Children’s partners with many colleges and universities to train health professionals from a variety of disciplines
including: nursing; mid-level practitioners; respiratory therapy;
occupational and physical; speech therapy; audiology; clinical
nutrition; pharmacy; child life; social work; and radiology to
learn about pediatrics. NIDCAP concepts have been integrated
into mentoring and shadowing experiences within the nursery
and are provided to foster a comprehensive understanding of
infant development as well as support professional learning and
growth. The developmental team is used as a resource to share
their unique knowledge with professionals who seek to better
understand infant behavior and development.
The Connecticut Children’s NIDCAP Training Center has
focused on four key elements of individualized developmentally
supportive care: interactions with infants as care is provided;
family-centered care principles; the sensory environment including the physical as well as the emotional atmosphere; and mutually supportive relationships among the care team.
The intensive care nursery has strengthened and expanded
developmental services to create a cohesive multidisciplinary
developmental team from physical therapy, occupational therapy
and nursing. This team has redefined service criteria, assessment
strategies, documentation and integration into the health team
incorporating therapeutic principles within the NIDCAP framework. Historically a nurse developmentalist provided assessments
and input to the health team which utilized therapeutic consultations for specific complex medical diagnosis. The rehabilitation
department has embraced NIDCAP principles and has encouraged their staff to participate in multiple educational opportunities. Resources from speech therapy and craniofacial services
are also utilized as needed to support the infant’s developmental
needs. The developmental team continues to create strong foundations for infant interactions and experiences collaborating with
the health care team.
The nursery leadership at Connecticut Children’s takes pride
in supporting an environment of innovation, creating a culture
of continued growth and learning, exploring new ideas and
creating dynamic teams embedded in strong family centered care
principles partnering with families. The intensive care nursery
uses a collaborative approach with resources from families, nutrition, social work, lactation consultants, developmental specialist,
nursing, case managers, advanced practice and medicine to create
individualized plans of care to support each infant in the nursery.
In addition to medical rounds the multidisciplinary care team
meets on a regular basis with families to define and update the
infant’s plan of care. A nursing discharge coordinator facilitates
transitional plans of care with each family having input from
each discipline as the infant is discharged from the nursery to
ease the transition for the infant and family.
Connecticut Children’s nursery is nationally recognized as a
center for excellence for low infection rates, high ratings in family and patient satisfaction and has been a pioneer in supporting
a mother’s desire to breastfeed their premature and/or critically
ill infant. Three board certified Lactation Consultants and 23
Certified Lactation Counselors from various disciplines within
the hospital provide extensive lactation services with a multitude
of clinical lactation services to support the use of breast milk in
the intensive care nursery and hospital setting. The Lactation
Consultants provide support to lactating mothers throughout
the hospital including the emergency department and feeding
team clinics with one on one consultation services and integration into the health care team. All families who receive inpatient
or outpatient lactation services receive follow up phone calls for
at least four weeks after discharge. The intensive care nursery has
established human donor milk as the standard of care for all very
low birth weight infants if their mother is not able to provide
milk of her own. A variety of annual educational opportunities
are provided to all hospital staff to enhance their knowledge and
competence to support breast milk fed infants. The staff is also
encouraged and supported to provide breast milk to their own
children with free in-home lactation services, comfortable private
rooms to express their milk while they are at work and reduced
fees to rent electric breast pumps.
The hospital is committed to partnering with families to
provide exceptional care to children and has collaborated with
the Institute of Family-Centered Care to strengthen familycentered care practices throughout the hospital. Many familycentered care strategies have been implemented with changes
in the physical environment, training to hospital staff, and the
creation of a resource library for families. The family resource
library is available 24 hours a day. It is located in a private room
with comfortable overstuffed leather sofa and chairs, a separate
desk area with a computer which has internet services, a large
bookshelf lined with books, videos and CDs as well as a television are available for families to use in this room. A nursery
education committee maintains the library and assures the
resources provided are current and comprehensive. A few years
back, a hospital-wide Family Advisory Board was created with a
nursery based Family Advisory Board following to provide input
into the nursery’s many aspects of decision making. Families are
integrated into daily medical rounds which increases partnerships and communication regarding individualized plans of care.
Privacy is sustained by speaking with soft voices during rounds
at each bedside. Occasionally, rounds or a formal interdisciplinary discussion of the infant’s plan of care will take place in a
separate private room close to the nursery if the conversation is
anticipated to be difficult or disruptive to the nursery. When this
happens the care team often will consult with the family on their
preference for where they would like to have the conversation.
The family is encouraged to participate and bring forth their
priorities during rounds. Although the nursery staff was initially
apprehensive and concerned with privacy and impacts on sounds
levels in the nursery, the transition to include all families was
eased as the physician group and nursery leadership modeled
successful implementation.
Connecticut Children’s is a growing dynamic organization
committed to improving the lives of children and their families.
From the Editors
We invite you to write us with your comments
regarding the content of any of the columns presented in this newsletter.
We are also interested in any suggestions that you
have with regard to future topics that you would like
to see addressed in the Developmental Observer.
Please contact us at: developmentalobserver@
nidcap.org.
Developmentally yours,
Rodd Hedlund, MEd
Senior Editor
Sandra Kosta, BA
Associate Editor
Deborah Buehler, PhD
Associate Editor
gretchen Lawhon, RN, PhD
Associate Editor
Developmental Observer
•
2011
•
13
C U R R E N T D E V E L O P M E N TA L R E S E A R C H
Inga Warren, Dip COT, MSc
An International Scientific
Symposium on Very Early
Interventions for Infants
Born Too Early
Stockholm, Sweden, 2010
I
n November, 2010 the Karolinska Institute, Stockholm,
Sweden hosted a second international scientific meeting on
“Ultra Early Intervention,” allowing the Danderyd, Sweden site
to proudly share their transformation to a Couplet Care Unit.
Hugo Lagercrantz, MD, PhD opened the day with a discussion of fetal and preterm consciousness,1 citing recent work on
Resting State Networks (RSN) and cortical responses to pain
as examples of a growing body of neuro-evidence for preterm
consciousness. It appears that the perspectives of neuroscientists
and behavioral observers are converging, adding weight to the six
presentations that followed, each of which included behavioral
observation as part of family centered care.
Zack Boukydis, PhD, University of Turku, Finland described a project that trains NICU staff to join parents in observing and interpreting the meaning of infant behavior, which
he hypothesizes leads to improved care for the infant. Training
begins with a week of lectures and demonstrations, followed by a
month of paired practice with a mentor and supervision groups.
Observations are made utilizing the NICU Network Neurobehavioral Scale.2,3,4 At the time of this presentation, 50% of the
staff on the NICU had been trained and it was anticipated that
mentors would lead the rest of the staff through the program in
the third year. During 2011, a pre- and post-cohort comparison
will be made using measures that evaluate the effect on staff and
parents as well as infant development.
Margot Forcada Guex, PhD, Department of Pediatrics,
University Hospital at Lausanne, Switzerland gave an update on
the maternal stress study5 looking at the effect of an intervention
program on prematurely born children’s endocrine responses to
separation. The infants were randomized to an intervention that
included joint observations with parents at 33 weeks, followed
by the administration of the Neonatal Behavioral Assessment
Scale6 and a clinical interview at term, plus sessions of interactive guidance with parents including video recordings. Salivary
cortisol measures were compared with mothers who reported
symptoms of post-traumatic stress at 12 months corrected age.
The hypothesis was that the intervention would counteract the
tendency for maternal stress to affect children’s stress reactivity.
There was a trend in this direction that was not significant; possible reasons were discussed.
14
•
2011
•
Developmental Observer
The Infant Behavioral Assessment and Intervention Program
(IBAIP)7conceived and developed by Rodd Hedlund, MEd applies the conceptual framework of the Synactive Model8 and the
NIDCAP 9 approach to care to a neurobehavioral developmental
support program for high risk infants recently discharged from
the hospital NICU/SCN. Infants and their families begin receiving IBAIP intervention when the infant is one month old (corrected age). A team of researchers, Karen Koldweijn, PhD and
Marie-Jeanne Wolf, PhD, Academic Medical Center, University
of Amsterdam, Amsterdam, The Netherlands have been the first
in Europe to test this intervention approach. In two earlier pilot
studies investigating the IBAIP, Koldweijn and Wolf10-11 found
that the Infant Behavioral Assessment (IBA)12 was a valuable
instrument in discriminating differences in self-regulation, and
that the IBAIP improved scores on the Bayley Scales of Infant
Development (BSID-II)13
Karen Koldweijn, PhD presented the most recent results
of two IBAIP randomized controlled trials. In the first study,
infants in the experimental group (n=86) received one hospital
visit shortly before discharge from the hospital, and six to eight
intervention visits at home, until they reached six months corrected age.14 Parents were guided by an IBAIP trained pediatric
physical therapist to observe their infant’s self-regulatory competence and the child’s attempts to process and explore information during a social or caregiving interaction. Parents were also
encouraged to offer their infant co-regulatory support and/or
modify the environment based upon the infant’s behavioural
communication. Infants in the control group (n=90) received
regular care. Developmental and behavioral outcomes were
evaluated at six months corrected age with the Bayley Scales of
Infant Development-II (BSID-II). Neurobehavioral functioning
was evaluated with the Infant Behavioral Assessment (IBA) at
baseline and at six months corrected age. Despite randomization, some differences in neonatal characteristics were found
between the intervention and control infants. After adjustment,
intervention effects of 7.2 points (± standard error 3.1) on the
Mental Developmental Index (MDI) and 6.4 ± 2.4 points on
the Psychomotor Developmental Index (PDI) of the BSID-II
favored the intervention infants. The Behavioral Rating Scale of
the BSID-II (P ± .000) and the IBA (more approach [P ± .003]
and less stress [P ± .001] over time) also favored the intervention
infants.
The second study presented by Koldweijn consisted of follow-up evaluations of both the experimental and control groups,
cited above, at 24 months of age.15 Development and behavior
were evaluated with the BSID-II and the Child Behavior Check
List (CBCL).16 Eighty-three intervention and 78 control infants
were available for follow-up. After adjustment for differences in
perinatal characteristics, an intervention effect of 6.4 points
(± standard error, 2.4) on the PDI of the BSID-II favored the
intervention infants. Groups did not differ on the MDI or
the Behavioral Rating Scale of the BSID-II, or on the CBCL.
However, in post hoc analyses, the investigators found improved
motor as well as improved mental development after IBAIP
intervention in subgroups of children with BPD and children
with multiple risks. In addition, significantly fewer intervention infants received paramedical services after 6 months, and
they were more compliant with follow–up, which underlines the
positive effects of the intervention. Further studies are warranted
to explore these promising effects of the IBAIP in high-risk
infants.29
The Dutch government is currently supporting the adoption
of the IBAIP as a standard of care for all high risk preterm infants, with ongoing nationwide IBAIP Training for all pediatric
physical therapists. All studies relating to IBAIP as well as those
cited above, may be found at: www.ibaip.org; click on “Evidence
Based Research: IBAIP.
In the 1980s a study in Vermont trialled the Mother Infant
Transaction Programme (MITP)17,18 which introduced parents
to infant behavioral communication through a series of teaching sessions during and just after their stay on the neonatal unit.
This small study was intriguing because the developmental
benefits seemed to increase as the children grew up. Marianne
Norhhov, MD presented the results of a randomised trial using a
modified version of the MITP conducted by a team of researchers at the Department of Pediatrics, University of North Norway
and the University of Tromsø, Norway (146 preterm infants and
57 non-randomized term controls). The intervention consisted
of seven in-hospital intervention sessions and four home interventions sessions (at 3, 14, 30, and 90 days after discharge). This
study found no significant developmental benefit at two years of
age19 but by five years of age the intervention babies had significantly higher IQ scores.20 In addition, parenting stress scores
showed that both mothers and fathers in the experimental group
had much lower stress level than those of preterm controls, and
were similar to term controls over the five year period. Child
rearing attitudes21 were also more positive and parents reported
fewer behavioural problems, particularly with attention. The
intervention was introduced towards the end of the hospital stay
and it was speculated that parents may have been most receptive at this stage when their infant had become more medically
stabilized and had developed a more trusting relationship with
the nurses.
Annica Ötenstrand, PhD, Karolinska Institute, Stockholm,
Sweden presented the results of a study entitled the Stockholm
Neonatal Family Centered Care Study.22 The aim of this study
was to increase family participation in the care of their infant.
Families were randomly assigned to a Family Centered Care
group (experimental) or Standard Care group (control) on admission of the infant (n=386 families and their infants; 186 per
group). Parents in the experimental group were provided the use
of a private room 24 hours a day, from the first day of their
infant’s admission to discharge (the room was located on the
nursery ward). The infant would then join the family in this
room as soon as the infant was medically stable. Those parents
assigned to the control group received standard care. The primary outcome was the effect on the infant’s length of stay which
was reduced by 5.3 days (p 0.05) for the experimental group,
most of which was accounted for by time spent in intensive care.
This study suggests: 1) that parents who spend most of their
time with their newborn may have a greater opportunity to interpret and act on signs of distress and other needs of the infant
compared with what is possible for the nursery staff, who have
more than one infant to care for; and 2) parental presence may
also contribute to better sleep organization which may promote
improved brain maturation. In addition, mothers in the experimental group, reported less mental distress at discharge and
again at the infant’s three months corrected age after discharge.
These presentations were part of a day full of interest and
excellent networking opportunities. All the presentations, and
also those from the 2009 symposium, are available on the
internet: http://web22.abiliteam.com/ability/show/khcichp/abbott_20101118/speed.asp. This will take you to the conference
home page; sign in and then click on: “VISA.” A second Conference on Ultra Early Intervention is scheduled for March 15,
2012.
References
1. Lagercrantz H, Changeux JP. Basic consciousness of the newborn. Seminars in Perinatology.
2010; 34 (3): 201-206.
2. Lester BM, Tronick EZ, Brazelton TB. The neonatal intensive care unit network neurobehavioral scale procedures. Pediatrics. 2004; 113 (3, Pt 2): 641-667.
3. Lester BM, Tronick EZ. History and description of the neonatal intensive care unit network
neurobehavioral scale. Pediatrics. 2004; 113 (3, Pt 2): 634-640.
4. Boukydis CF, Bigsby R, Lester BM. Clinical use of the neonatal intensive care unit network
neurobehavioral scale. Pediatrics. 2004; 113 (3, Pt 2): 679-689.
5. Forcada-Guex M, Borghini A, Pierrehumbert B, Ansermet F, Muller-Nix C. Prematurity, maternal posttraumatic stress and consequences on the mother-infant relationship. Early Human
Development. 2011; 87 (1): 21-26.
6. Brazelton TB, Nugent K. The Neonatal Behavioral Assessment Scale. 1995. MacKeith Press.
7. Hedlund R. The Infant Behavioral Assessment and Intervention Program. Seattle, Washington:
Washington Research Institute, 1991. Available at: http://www.ibaip.org
8. Als H. A synactive model of neonatal behavioral organization: Framework for the assessment
and support of neurobehavioral development of premature infants and their parents in the
environment of the nicu. In JK Sweeney, Physical and Occupational Therapy in Pediatrics. New
York: Haworth Press, 1986.
9. Als H, Lawhon G, Brown E, Gibes R, Duffy FH, McAnulty G, Blickman JG. Individualized
behavioral and environmental care for the very low birth weight preterm infant at high risk
for bronchopulmonary dysplasia: neonatal intensive care unit and developmental outcome.
Pediatrics.1986; 78: 1123–1132.
10.Wolf MJ, Koldewijn K, Beelen A, Hedlund R, de Groot IJ. Neurobehavioral and developmental profile of very low birth weight preterm infants in early infancy. Acta Paediatr. 2002;
91:930-8.
11.Koldewijn K, Wolf MJ, van Wassenaer A, Beelen A, Nollet F, Kok JH. The infant behavioral
assessment and intervention program to support preterm infants after hospital discharge: A
pilot study. Developmental Medicine and Child Neurology. 2005; 47:105-12.
12.Hedlund R, Tatarka M. Infant Behavioral Assessment. Seattle, Washington: Washington
Research Institute, 1988. Available at: http://www.ibaip.org
Continued on page 18
Developmental Observer
•
2011
•
15
S U P P O R T I N G FA M I L I E S
Melissa R Johnson, PhD
Single–Room NICU Care:
What does it mean for
developmental care?
I
n the past several decades, there has been a slow but accelerating trend in Newborn Intensive Care Unit (NICU) design
toward increasing privacy for infants and families.1-3 For many
involved in developmentally supportive, family-focused care, it
has always been a mystery why fragile infants and their families
seem to represent the last population to be cared for in a manner honoring their individuality and humanity equal to that of
any other patient. Gradually, however, this picture is changing.
As designs have progressed from the antiquated “baby barns”
where individualizing the environment was almost impossible,
to individual rooms allowing families to be nurtured and to
nurture their infant together, many important issues need to be
considered by those who provide developmental leadership in
the NICU.
Julie Swanson,4 RN, BSN, a developmental educator at St.
Luke’s Regional Medical Center in Boise, Idaho, was asked to reflect on the journey in her unit toward more private and peaceful
environments. Her thoughts are shared below; some of the issues
she raises will then be discussed.
Several years ago our NICU was remodeled and we
transformed our unit. We went from a unit of three large rooms
with numerous infants in one room to a unit of multiple rooms
with a maximum of three infants in one room. We added three
rooming-in rooms where parents can stay overnight with their
infant while their child is monitored and staff is available for
any medical needs the infant might have. The new layout has
come with challenges and many benefits for both the staff and
the families under our care.
The most significant change I have seen is the decrease in
sound and activity levels within the nursery. One of the first
things people say when they come into our nursery is “It is so
quiet here.” This is due to the addition of carpeting, ceiling tiles
and interior walls, as well as the ability to close doors. With only
a few patients in one room, the infants have limited exposure
to fluctuating activity and sound levels. We now may place an
infant in a private room for protection from stimulation or to
provide privacy for the family.
The ability to offer family privacy is of great benefit to the
infant and family alike. In our old unit, we had limited ability
to change the environment for the infant and family. We could
only place one upright chair next to the bed; had only a drawn
16
•
2011
•
Developmental Observer
curtain to offer privacy; and had limited control over the light,
sound and activity level within the nursery. Now, an infant
may experience skin-to-skin holding with both parents seated
in large reclining chairs at the bedside, with the lights turned
off, the curtain drawn, and the door closed. The family can rest
together and they stay for longer periods of time.
Families are encouraged to decorate the room as if it were
their infant’s private nursery room. There are shelves for the
placement of stuffed toys, ‘knick knacks” and books; dressers for
family and infant personal items; a choice in seating; wall space
to hang pictures, and windows to look out of. If there are twins
or other multiples, they are all placed in the same room, or
adjoining rooms if necessary, so that parents can be with all of
their children at one time. In this way the family is available to
the infant at all times.
It used to be that when an infant was admitted, every staff
person, infant and parent experienced this admission. Now, this
scenario has been alleviated with the remodeling of our nursery.
This is wonderful for the infant and family. The creation of
our new nursery has, however, been quite an adjustment, and
difficult for some of our staff. Prior to the nursery remodel, most
of the staff could easily observe what was taking place in the
nursery and offer assistance when needed. Now, the staff must
physically take the time to ask for help.
One of the biggest concerns for the nursery is staffing. It
often takes more staff to care for the number of infants due
to the location of each of the infant’s bedside. We try to avoid
moving infants from one room to another to help with staffing.
However, this frequently occurs due to the availability of staff
and their skill level. In addition, the coordination of staff breaks
is more difficult because we have a standard that a staff person
must be immediately present to respond to the infants’ and families’ needs.
Each paragraph in Ms. Swanson’s reflections contains both
valuable wisdom and springboards for discussion. To begin with
a few key issues, she describes one model on the continuum. In
addition to the model of multiple smaller “semiprivate” rooms
with several rooms accommodating families with their babies,
some units incorporate a limited number of single rooms along
with several larger open bay rooms, while still others have accomplished a transition to completely private rooms for all
babies and families. The most advanced level of care, to be the
topic of a later article, may be the concept of “couplet care” and
skin-to-skin holding, allowing simultaneous care of mother and
premature baby. The small amount of literature that is emerging
on the various models points to advantages and challenges with
each model. For example, Greer5 notes the possibility that in
“mixed” models, stresses may emerge as families note that not all
infants have access to the same level of privacy and space.
As early observational research begins to emerge, however, the
advantages of single-room care reflected in Ms. Swanson’s lived
experience are being supported. Ambient sound, lighting, and
even air quality have been found to show significant advantages in
individual rooms.6 The vastly improved privacy provided by single
rooms appear to be facilitating increased participation in skinto-skin holding, as well as improvements in breastfeeding success
rates, both of which may be expected to have significant positive
effects on developmental outcomes and family functioning.6,7
Concerns that have been raised, including those noted by
Ms. Swanson, include staffing and their associated cost issues;
questions of staff and/or parent isolation; as well as safety issues
raised by those who are accustomed to having direct visual observation of infants most of the time. Interestingly, early-published
observations appear to be indicating that these issues either do
not present the problems that were anticipated, or are prevented
with good planning. In fact, Domanico6 noted several safety and
infection control dimensions that favored the infants in singleroom care.
It will be very interesting to observe the progress of this
model of care and the results for infants and families. Perhaps of
greatest interest is the thought that the evolution of NICU care
will progress toward models that have been suggested by pioneers
in Sweden,8 Argentina,9 and South Africa,10 where the unit of
care is the mother-baby pair, as intended by human evolution
and neurobiology.
References:
1. Browne J. New perspectives on premature infants and their parents. Zero to Three. November,
2003; 1-12.
2. White RD, Individual rooms in the NICU- an evolving concept. 2003; 23 (Supplement 1);
S22-S24.
3. Hauser C. For the tiniest babies, the closest thing to a cocoon. New York Times, 5/29/2007.
4. Swanson J. Personal communication, May 26, 2011.
5. Greer, B. NICU’s: Why single rooms? 2011. Paper presented at the NICQ 7/Vermont-Oxford
Network Conference.
6. Domanico R, Davis DK, Coleman R, & Davis BO. Documenting the NICU design
dilemma: Comparative patient progress in open-ward and single family room units. Journal of
Perinatology. 2011; 31, 281-288.
7. Lester BM, Miller RJ, Hawes K, Salisbury A, Bigsby R, Sullivan MC, & Padbury JF. Infant
neurobehavioral development. Seminars in Perinatology, 2011; 35, 8-19.
8. Lillieskold, S, & Westrup, B. Family centered neonatal couplet care: Scientific context &
implementation in practice “the Karolinska Way.” 2011. Paper presented at Neonatal Couplet
Care Conference.
9. Basso, G. Skin-to-skin holding: The Argentinean experience. 2009. Paper presented at the
19th Annual NIDCAP Trainers Meeting.
10.Bergman, NL, Linley, LL, & Fawcus, SR. Randomized controlled trial of skin-to-skin contact
from birth versus conventional incubator for physiological stabilization in 1200 to 2199-gram
newborns. Acta Paedriatica. 2004; 93, 779-785.
Developmental Care in
the Moment
Intimacy and room for all
Photograph by Inga Warren, Dip COT, MSc
Developmental Observer
•
2011
•
17
FA M I LY V O I C E S
Continued from page 11
we had survived. He said he was familiar with the NIDCAP
approach. He cited statistics about Kangaroo care, parental
involvement, and shortened hospital stays as well as decreased
re-admittance rates. He shared with me one of the most profound statements that I continue to remind myself to this day,
and which would become particularly useful in years to come as
we welcomed more children into this world. He said, “The practice of medicine is just that, it is PRACTICE, and it is ultimately
your decision to allow medical professionals to practice on your
child.”
Abby was discharged after 16 days of intensive care and an
additional day in the special care nursery where I was encouraged
to room in with and completely care for my bundle of joy. James
and I administered all the necessary procedures and medications that would be needed at home. We felt triumphant and
confident caring for our baby; quite in contrast to prior experiences, where the predominant feeling of elation at discharge was
matched by insecurity about our abilities. Oftentimes, making
appropriate care decisions; interpreting preterm infant behavior; and attempting to understand the best way to protect and
encourage bonding, development and support felt ambiguous at
best. Today, Abigail is a healthy 15 year old who excels in school.
The NIDCAP approach to care has provided parents the
priceless gift of confidence and determination, supporting
them in their appropriate role as parents despite the daunting
cirumstances that may lie ahead of them. NIDCAP certified
professionals and nurseries have gradually helped to change hospital nurseries around the world. Health care professionals and
medical facilities have steadily come to a more complete understanding of the undeniable positive outcomes of individualized,
developmental, relationship-based care…a portal to
infant health.
Over the years as our family has continued to grow, we have
experienced the NICU with the birth of each of our other six
children. Each birth has presented its own special challenges, but
we also became aware of the gradual changes in the nursery, and
the care provided, that has taken place over the course of the last
18 years. The NICU can be a place that annihilates parents causing indefinable harm to families. With every subsequent NICU
we have been a part of over the last 18 years, changes are evident
regarding preterm behavioral understanding and support for
both the families and the babies.
It has been almost a year now since I had the awe inspiring experience of seeing my darling Jenna cradle her tiny baby
brother in her gentle arms as we sat in the NICU in April. Tears
fell unrestrained as I was overcome with the realization that my
beautiful daughter possessed all the confidence that had been
initially ripped from me in those first few days after her birth. It
will be a miraculous day when the norm is supporting parents
and giving them the gift of confidence to care for these precious
miracles born too early. I am of the opinion that the NIDCAP
philosophy of caregiving quite possibly could prevent scenarios of
child abuse, failure to bond, failure to thrive, and other such catastrophic events that have an irreversible negative impact on families. I am indescribably grateful for the blessing that NIDCAP has
bestowed upon nearly two generations of our family.
C U R R E N T D E V E L O P M E N TA L R E S E A R C H
13. Bayley N. Manual for the Bayley Scales of Infant Development—II. San Antonio, TX: Psychological Corporation, 1993.
14. Koldewijn K, Wolf MJ, van Wassenaer A, Meijssen D, van Sonderen L, van Baar A, Beelen
A, Nollet F, Kok J. The Infant Behavioral Assessment and Intervention Program for very low
birth weight infants at 6 months corrected age. Journal of Pediatrics. 2009; 154(1): 33-38.
15. Koldewijn K, van Wassenaer A, Wolf MJ, Meijssen D, Houtzager B, Beelen A, Kok J, Nollet
F. A neurobehavioral intervention and assessment program in very low birth weight infants:
Outcome at 24 months. Journal of Pediatrics. 2010; 156 (3): 359-365.
16. Achenbach TM & Rescorla LA. Manual for the ASEBA Preschool Forms & Profiles. Burlington, VT: University of Vermont, Research Center for Children, Youth, & Families; 2000.
17. Rauh VA, Nurcombe B, Achenbach T, Howell C. The mother-infant transaction program.
The content and implications of an intervention for the mothers of low-birthweight infants.
Clinics in Perinatology. 1990; 17(1): 31-45.
Continued from page 15
18. Achenbach TM, Howell CT, Aoki MF, Rauh VA. Nine-year outcome of the vermont intervention program for low birth weight infants. Pediatrics. 1993; 91(1): 45-55.
19. Kaaresen PI, Rønning JA, Tunby J, Nordhov SM, Ulvund SE, Dahl LB. A randomized
controlled trial of an early intervention program in low birth weight children: Outcome at 2
years. Early Human Development. 2008; 84(3): 201-209.
20. Nordhov SM, Kaaresen PI, Rønning JA, Ulvund SE, Dahl LB. A randomized study of the
impact of a sensitizing intervention on the child-rearing attitudes of parents of low birth
weight preterm infants. Scandinavian Journal of Psychology. 2010; 5(1): 385–391.
21. Nordhov SM, Rønning JA, Dahl LB, Ulvund SE, Tunby J, Kaaresen PI. Early intervention
improves cognitive outcomes for preterm infants: Randomized controlled trial. Pediatrics.
2010; 126, (5): e1088-94.
22. Örtenstrand A, Westrup B, Broström EB, Sarman I, Åkerström S, Brune T, Lindberg L,
Waldenström U. The stockholm neonatal family centered care study: Effects on length of
stay and infant morbidity. Pediatrics. 2010; 125(2): e278-285.
We invite you to send in information that you may encounter, such as upcoming conferences, websites, books, journals,
articles, videos, etc., that may be shared with our readers. Please send items for inclusion in the Developmental Observer to
Joke Weilenga, RN, PhD at: j.wielenga@amc.uva.nl.
18
•
2011
•
Developmental Observer
Developmental
Observer
The Official Newsletter of the NIDCAP®
Federation International
To download the Developmental Observer
please go to: nidcap.org
NIDCAP Federation International Board of Directors and Staff
President
Heidelise Als, PhD
NIDCAP Senior Master Trainer
APIB Master Trainer
Director, National NIDCAP
Training Center
email: heidelise.als@childrens.harvard.edu
Vice President
gretchen Lawhon, RN, PhD
NIDCAP Master Trainer
Director, Mid-Atlantic NIDCAP Center
email: lawhon-gretchen@cooperhealth.edu
Secretary
Deborah Buehler, PhD
NIDCAP Master Trainer
APIB Trainer
Associate Director, West Coast NIDCAP
and APIB Training Center
email: deborahbuehler@comcast.net
Treasurer
Gloria McAnulty, PhD
National NIDCAP Training Center
email: gloria.mcanulty@childrens.harvard.edu
Assistant Secretary/Treasurer
Sandra Kosta, BA
National NIDCAP Training Center
email: sandra.kosta@childrens.harvard.edu
Jeffrey Alberts, PhD
Professor, Psychological and Brain
Sciences, Indiana University
email: alberts@indiana.edu
James M. Helm, PhD
NIDCAP Senior Trainer
Director, Carolina NIDCAP
Training Center
email: jhelm@wakemed.org
Silke Mader
Founder, European Foundation for the
Care of Newborn Infants
email: silke.mader@efcni.org
Jacques Sizun, MD
Director, French NIDCAP Center
email: jacques.sizun@chu-brest.fr
Kathleen VandenBerg, PhD
NIDCAP Master Trainer
Director, West Coast NIDCAP and APIB
Training Center
email: vandenbergk@peds.ucsf.edu
Inga Warren, Dip COT, MSc
NIDCAP Trainer
Director, UK NIDCAP Training Centre
at St. Mary’s
email: inga.warren@imperial.nhs.uk
Victoria Youcha, EdD
Child Development Specialist
Children’s Medical Associates
email: vyoucha@gmail.com
Rodd Hedlund, MEd
Director
NIDCAP Nursery Certification Program
email: nncpdirector@nidcap.org
Developmental Observer
•
2011
•
19
NIDCAP TRAINING CENTERS
by order of establishment
National NIDCAP Training Center
Children’s Hospital Boston and
Brigham and Women’s Hospital
Boston, Massachusetts, USA
Director: Heidelise Als, PhD
Contact: Sandra M. Kosta, BA
email: nidcap@childrens.harvard.edu
Mid-Atlantic NIDCAP Center
The Children’s Regional Hospital at
Cooper University Hospital
Camden, New Jersey, USA
Director and Contact:
gretchen Lawhon, RN, PhD
email: lawhon-gretchen@cooperhealth.edu
UK NIDCAP Training Centre at St. Mary’s
St. Mary’s Hospital
Imperial College Healthcare NHS Trust
London, England
Director and Contact:
Inga Warren, Dip COT, MSc
email: inga.warren@imperial.nhs.uk
Sooner NIDCAP Training Center
University of Oklahoma Health
Sciences Center
Oklahoma City, Oklahoma, USA
Co-Director: Andrea Willeitner, MD
Co-Director and Contact:
Eleanor (Bunny) Hutson, RN
email: bunny-hutson@ouhsc.edu
Karolinska NIDCAP Training Center
Astrid Lindgren Children’s Hospital at
Karolinska University Hospital
Stockholm, Sweden
Director: Björn Westrup, MD, PhD
Contact: Ann-Sofie Ingman, RN, BSN
email: nidcap@karolinska.se
Children’s Hospital of University of
Illinois (CHUI) NIDCAP Training Center
University of Illinois Medical Center
at Chicago
Chicago, Illinois, USA
Director: Beena Peters, RN, MS
Contact: Jean Powlesland, RN, MS
email: jpowlesl@uic.edu
West Coast NIDCAP and APIB
Training Center
University of California San Francisco
San Francisco, California, USA
Director and Contact:
Kathleen VandenBerg, PhD
email: vandenbergk@peds.ucsf.edu
Carolina NIDCAP Training Center
WakeMed, Division of Neonatology
Raleigh, North Carolina, USA
Director and Contact: James M. Helm, PhD
email: jhelm@wakemed.org
Colorado NIDCAP Center
University of Colorado Denver
School of Medicine and The Children’s
Hospital
Aurora, Colorado, USA
Director and Contact:
Joy V. Browne, PhD, PCNS-BC,
IMH (IV) Mentor
email: joy.browne@childrenscolorado.org
St. Luke’s NIDCAP Training Center
St. Luke’s Children’s Hospital
Boise, Idaho, USA
Co-Director:
Beverly Holland, MSN, RN, NE-BC
Co-Director and Contact:
Karen M. Smith, RNC, BSN, MEd
email: smithka@slhs.org
Connecticut Children’s NIDCAP
Training Center
Connecticut Children’s
Hartford, Connecticut, USA
Co-Director: Ann Milanese, MD
Co-Director and Contact:
Dorothy Vittner, RN, MSN
email: dvittner@ccmckids.org
French NIDCAP Center
Medical School, Université de Bretagne
Occidentale and University Hospital
Brest, France
Director: Jacques Sizun, MD
Contact: Nathalie Ratynski, MD
email: nathalie.ratynski@chu-brest.fr
Sophia NIDCAP Training Center
Erasmus MC-Sophia Children’s Hospital
Rotterdam, The Netherlands
Director: Nikk Conneman, MD
Contact: Monique Oude Reimer, RN
email: nidcap@erasmusmc.nl
Centro Latinoamericano NIDCAP
& APIB
Fernández Hospital
Fundación Dr. Miguel Margulies and
Fundación Alumbrar
Buenos Aires, Argentina
Director and Contact:
Graciela Basso, MD, PhD
email: basso.grace@gmail.com
NIDCAP Training and Research Center at
Cincinnati Children’s
Cincinnati Children’s Hospital Medical Center
Cincinnati, Ohio, USA
Director: Whittney Brady, MSN, RN
Contacts: Tammy Casper MSN, MEd, RN
or Linda Lacina, RN
email: nidcap@cchmc.org
The Brussels NIDCAP Training Center
Saint-Pierre University Hospital
Free University of Brussels
Brussels, Belgium
Director: Dominique Haumont, MD
Contact: Delphine Druart, RN
email: delphine_druart@stpierre-bru.be
Ålesund Hospital NIDCAP Center
Ålesund Hospital
Ålesund, Norway
Co-Director: LivEllen Helseth, RN
Co-Director and Contact: Unni Tomren, RN
email: unnitomren@gmail.com
Become a Member of the NFI
The NFI has expanded opportunities
for membership. Please join us!
For more information and the online
application form, visit our website at:
www.nidcap.org/membership.aspx, or
email us at nfimembership@nidcap.org
www.nidcap.org